Risk and significance of venous air embolism at neurosurgical operations in the position of sitting at adults. Article

Abstract

Background. Currently, the patient's sitting position has largely lost popularity among neurosurgeons mainly due to fears of possible complications. This position involves certain risks, the most dangerous of which are venous air embolism and paradoxical air embolism. Materials and methods. We report a retrospective study that included 66 neurosurgical patients operated on in a sitting position in 2 years. Preoperative examination, anesthetic management, and intraoperative monitoring have been standardized. The analysis included data from anesthetic charts and protocols of intaoperative monitoring. Results. Of 66 patients, 24 (36 %) were diagnosed with patent foramen ovale using contrast transesophageal echocardiography with Valsalva breakdown. The anomaly was not considered as a contraindication for surgery in a sitting position. Venous air embolism during surgery was diagnosed in 34 patients (51.5 %). However, clinically significant complications developed in 3 patients (4.5 %). None of the patients had complications requiring therapy in the postoperative period. Conclusion. Our study shows that an anaesthetic support model like ours is effective in preventing major complications associated with the patient's sitting position. The fear of fatal complications seems unfounded.

Comment on the article of R.S. Lakotko et al. “Risk and significance of venous air embolism at neurosurgical operations in the position of sitting at adults”

“…Эти клинические ситуации неоднократно описаны в литературе и, к сожалению, имели место и в нашей практике. Это одна из актуальных тем в современной нейроанестезиологии, и поэтому, на мой взгляд, необходимо поблагодарить авторов за то, что они обратились к этой проблеме [1]. Дизайн исследования выглядит вполне адекватным.…”